| National Provider Identifier [NPI]: | 1669495255 |
| Last Name Of The Provider | BLACK |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 146 N HOSPITAL DRIVE |
| Street Address 2 Of The Provider | SUITE 530 |
| City Of The Provider | WEST COLUMBIA |
| Zip Code Of The Provider | 291694894 |
| State Code Of The Provider | SC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 70 |
| Number Of Services | 7332 |
| Number Of Medicare Beneficiaries | 3148 |
| Total Submitted Charge Amount | 705343 |
| Total Medicare Allowed Amount | 180894.39 |
| Total Medicare Payment Amount | 128581.39 |
| Total Medicare Standardized Payment Amount | 137451.19 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 16 |
| Number Of Drug Services | 788 |
| Number Of Medicare Beneficiaries With Drug Services | 134 |
| Total Drug Submitted ChargeAmount | 29123 |
| Total Drug Medicare AllowedAmount | 13162.66 |
| Total Drug Medicare PaymentAmount | 10651.72 |
| Total Drug Medicare Standardized Payment Amount | 10651.72 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 54 |
| Number Of Medical Services | 6544 |
| Number Of Medicare Beneficiaries With Medical Services | 3148 |
| Total Medical Submitted Charge Amount | 676220 |
| Total Medical Medicare Allowed Amount | 167731.73 |
| Total Medical Medicare Payment Amount | 117929.67 |
| Total Medical Medicare Standardized Payment Amount | 126799.47 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 503 |
| Number Of Beneficiaries Age 65 to 74 | 1161 |
| Number Of Beneficiaries Age 75 to 84 | 917 |
| Number Of Beneficiaries Age Greater 84 | 567 |
| Number Of Female Beneficiaries | 1766 |
| Number Of Male Beneficiaries | 1382 |
| Number Of Non Hispanic White Beneficiaries | 2678 |
| Number Of Black or African American Beneficiaries | 407 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 26 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 21 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2486 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 662 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.6014 |